Perinatal psychiatric illness is the leading cause of maternal death in the US, and few centers train physicians in it
STUDY: Almeida M, JAMA 2026
STUDY TYPE: Editorial
FUNDING: Indpendent
Background
Perinatal psychiatric disorders touch about one in five women and are the leading cause of maternal death in the US, ahead of hemorrhage and hypertensive disorders.
The most serious of these, postpartum psychosis, affects around 1-2 in 1,000 mothers and caries a 4% risk of infantacide untreated. With treatment, which involves lithium and antipsychotics, 98% fully recover. Publicity around these cases is high — Andrea Yates (2001), Mine Ener (2003), Lindsay Clancy (2023–2026) — but meaningful action is low. Psychiatry has built little dedicated training, inpatient capacity, or drug development for pregnant and postpartum patients.
About 15 dedicated perinatal psychiatry training programs exist in the US, serving roughly 3.6 million births a year.
Zuranolone, approved in 2023, is the only oral drug specifically approved for postpartum depression and costs over $15,000 per course; the earlier infused neurosteroid, brexanolone, was withdrawn from the market.
Here are some of the gaps the essay highlights:
- Dedicated perinatal psychiatric inpatient beds are scarce here, and mothers are often separated from their infants when hospitalized psychiatrically. In contrast, European centers offer mother-baby units.
- Without training in perinatal-specific risk-benefit analysis, patients are often told to stop medications during pregnancy.
- Women were excluded from federally funded trials until 1993, and women’s health research still draws under 10% of NIH funding.
Racial and economic disparities compound the problems. The nurse who drowned her children during a psychotic episode received a hung jury, while Latarsha Sanders, a Black Massachusetts mother with a similar clinical picture, faced a harsher outcome, a disparity the author ties to race and how courts understand postpartum psychosis.
On a positive note, the Maternal Mental Health Hotline (1-833-852-6262) provides supports for crises, and many perinatal psychiatry programs offer consultation.
Practice Implications
- Treat postpartum psychosis as a psychiatric emergency, on par with eclampsia.
- Here’s how to diagnose and treat it.
- Involve the family, and guide them to peer support (Action on Postpartum Psychosis).
- There’s more on the Clancy case in 35 Minutes, where six psychiatrists discuss the implications (I was one of them).
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
